for living with diabetes

From a talk given at the UK launch of the new Type 2 treatment given by Viggo Birch, vice president and managing director, Novo Nordisk Ltd.

In addressing a press conference held to launch Victoza a new treatment for adults with Type 2 diabetes, Birch claimed that the once-daily injectable medicine will “change the way Type 2 diabetes is treated”. The first prescription of the drug to be written was on 3rd July in the UK only hours after the European Commission granted marketing authorisation.

Birch explained the background regarding the rocketing levels of diagnoses of Type 2 diabetes in the UK, and around the world, but noted that in fact as a condition it has to fight for attention. “It is a human, economic and social problem,” he said, “likely to affect 7-10% of the population within the next 10 years.”

He said estimates are now 3 to 4 million people with diabetes currently in the UK, although the statistics more usually quoted state 2.5 million have been diagnosed with diabetes and up to a further million people have it but don’t know it yet.

In the UK, legislation means Novo Nordisk can’t advertise prescription medicines direct to patients, medical advice is filtered down through the NHS, hospitals and GPs’ surgeries.

Birch joined Novo Nordisk 21 years ago when Type 2 diabetes was already being described as a pandemic. Novo Nordisk, like many pharmaceutical companies, is involved with research into a variety of different medical conditions but invests more money into diabetes research than any other company in the world and has approximately 70% of the UK’s insulin market (with its Novo Rapid and NovoMix and Levemir , with the other major players being Eli Lilly (Humalog) and Sanofi-Aventis (Lantus).

Type 1 diabetes is where there is no naturally produced insulin in the body because for reasons unknown the body destroys the cells that produce insulin. All people with Type 1 diabetes inject insulin and are sometimes referred to as insulin dependent. Type 2 diabetes is sometimes called insulin resistance; the condition is caused by an inability of the body to best use the insulin that is produced.

Initially people with Type 2 diabetes try diet and exercise to manage their condition, as the disease progresses they may go onto tablets and if these are not enough insulin therapy becomes the best course of treatment.

Type 2 diabetes is closely associated with obesity – fat itself has its own hormones, some of which inhibit how insulin is used. There’s a real issue surrounding Type 2 diabetes as being a condition that leads to social exclusion – you will have heard people saying that the NHS should not have to pay to sort out lifestyle problems, be they smoking, drug or alcohol addiction, cosmetic surgery or, in this case, Type 2 diabetes caused by being overweight.

So should the NHS be paying for a new drug to treat patients with Type 2 diabetes? Well that’s a massive question, but one thing is increasingly being statistically proven, which is that short-term costs of dealing with diabetes are far less expensive than dealing with the long-term consequences.

Victoza is not an insulin but one of the first of a new breed of injectable medications called a Glucagon-like peptide-1 (GLP-1), a hormone that stimulates the release of insulin only when blood sugars are too high in people with Type 2 diabetes. As Birch pointed out to the audience, in 2025 it’s predicted there will be 380 million people globally with diabetes, of which most cases will be type 2 diabetes and “this will change our healthcare economics.”

There is current evidence that as many as 60% of people with Type 2 diabetes (which to put into context would equate to the populations of France, Spain and Portugal added together) do not have blood sugars within the ideal range. Bad control (i.e. not within the normal range) leads to what are rather euphemistically called ‘diabetes complications – blindness, amputations, heart and kidney damage. Helping people with diabetes, whether Type 1 or Type 2, control with their condition with good medication and equipment to avoid the onset of diabetes-related complications is clearly preferable.

Birch talked about what an ideal treatment would look like, one aspect of which is that there would be little or no ‘trade off’ – that the medication would not have a downside, like raised blood pressure or weight gain, or indeed low blood sugar, known as hypoglycaemia. “Studies to date have shown that Victoza not only improves one side of your life but actually doesn’t impair any other part of your life,” said Birch, “An ideal drug would also lead to better control of complications and reach many people – Victoza, by helping to stabilise blood glucose levels with low risk of hypoglycaemia, and even reducing weight, fits into this ideal scenario. It’s also easy to take, and unlike insulin can be taken independent of meals giving patients control of their condition and the resultant freedom to live their lives to the full.”